Bonita Springs Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Marcella Tarin and Coryse Ngangmenyi conducted an unannounced annual inspection and met with Administrator (ADM) Syeda Lubna Haroon. LPAs stated the purpose of the visit. LPAs toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. The facility was observed to be clean, safe, sanitary and in good repair. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed the refrigerator temperature at 37 F and Freezer at -3 F. LPAs observed the knives as locked and inaccessible to residents. LPAs observed the medication storage area and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The facility fire extinguishers were last serviced on 6/19/2026. LPAs reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was conducted on 6/13/2026. LPAs toured 5 resident bedrooms with the ADM. All 5 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 LPAs toured 3 bathrooms. All 3 bathrooms had hand soap, hand towels and/or paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 107.4 F to 112.8 F. LPA toured the garage and it was observed to be used for storage purpose only. LPAs observed the facility laundry room located inside the facility next to the garage and is not accessible to residents in care. LPAs reviewed 3 resident records. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. Administrator provided LPAs with copies of valid administrator certificate and Lease agreement. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator (ADM) Syeda Lubna Haroon and a signed copy of this report was provided. Page 2 of 2 End of Reportthe state’s words, verbatim · CDSS document, Aug 6, 2026

Allegation investigated: Facility staff do not assist residents with medications at night. Facility staff do not evaluate the condition of the skin exposed to urine and stool to ensure skin breakdown, such as rash, is not occuring.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Syeda Haroon and stated the purpose of today’s visit. On 01/16/2026, the Department received a complaint with the above allegations. On 01/23/2026, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 3. Unfounded Page 2 of 3. Facility staff do not assist residents with medications at night. On 01/23/2026, the Department interviewed 3 staff (S1-S2) including Administrator (ADM) Syeda Haroon. ADM stated there are three staff in charge of administering medication: herself and S1 & S2 in the day time and there are two caregivers at night that will administer the medications to the residents. ADM stated there is a resident on Hospice so there is PRN medication available for the Hospice nurse to administer. ADM stated there are no issues she is aware regarding staff not administering medications at night and residents refusing medication at night. On 01/23/2026, the Department interviewed 4 residents (R1-R4). 1 Out of 4 residents was not available to be interviewed since they were sleeping and 1 Out of 4 residents was not able to provide answers to the questions. 2 Out of 4 residents (R2&R4) stated the staff assist resident with medications and night and both residents stated there have been no issues about medication administration to them or other residents at the facility. Based on review of 4 residents (R1-R4)’s Medication Administration Records (MARs) for December 2025 - January 2026, LPA Rai reviewed the staff initialed for each day and each dose administered to all residents. The MARs for all four residents were complete, and residents did not refuse any medications or any dose that was not accounted for by staff initials. The MARs documented all medications that were administered to the residents at night, and the staff initialed the dose given to the residents. On 3/18/2026, the Administrator provided payroll records for LPA to review to show the staff were present during the evening and night to provide medications to the residents. The Administrator stated she will also provide care and supervision during shifts that staff were not available. Page 3 of 3. Facility staff do not evaluate the condition of skin exposed to urine and stool to ensure skin breakdown, such as rash, is not occurring. On 01/23/2026, the Department interviewed 3 staff (S1-S2) including Administrator (ADM) Syeda Haroon. ADM stated there are 2 residents that need assistance with incontinence care. ADM stated there are no issues with incontinence care with the residents. ADM stated there are no issues with rash occurring on resident’s skin. ADM stated the staff will check the residents every 2-3 hours. ADM stated the facility did not have progress notes on file since there was no change of condition to report on the resident's skin, such as a rash. On 01/23/2026, the Department interviewed 4 residents (R1-R4). 1 Out of 4 residents was not available to be interviewed since they were sleeping and 1 Out of 4 residents was not able to provide answers to the questions. 2 Out of 4 residents (R2&R4) stated the staff assist with incontinence care and they have no skin issues with rash occurring. R2 stated their skin was itchy but their responsible party brought in cream to put on the skin, but R2 stated they did not have a rash. Based on review of 4 residents (R1-R4)’s LIC 602A Medical Assessment for Residential Care Facilities for the Elderly, 3 out 4 residents are both bowel and bladder incontinence and require assistance with toileting needs. 1 Out of 4 residents is bowel incontinence and require assistance with toileting needs. 2 Out of 4 residents have a history of skin conditions or breakdown. Based on review of 5 residents (R1-R5)’s LIC 625 Appraisal/Needs and Services Plan, 4 out 5 residents need assistance with all ADLs. R3 can complete his/her own hygiene tasks but needs assistance with staff providing and preparing the supplies. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 26-AS-20260116125052

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to address the deficiencies observed during a complaint investigation on 01/16/2026. LPA Rai met with Administrator, Syeda Haroon and stated the purpose of today's visit. During the complaint investigation, LPA Rai reviewed three resident's file (R1-R3) whose LIC 625 Appraisal/Needs and Services Plan was created by Administrator but it was not signed by resident or resident's responsible party. LPA Rai review one resident's file (R1) whose LIC 602A Medical Assessment for Residential Care Facilities for the Elderly was completed on 02/16/2026 after R1 was moved into the facility on 01/09/2026. During today's visit, Administrator stated R1's physician was hard to get a hold of prior to R1 moving into the facility and Administrator attempted for R1 to be seen by physician and obtain a medical assessment. Administrator stated R1's physician came to the facility on 02/16/2026 and assessed R1 at the facility. During today's visit, LPA Rai spoke with resident R1's responsible party (F1) who signed R1's LIC 625 Appraisal/Needs and Services Plan. F1 stated they had a hard time obtaining the LIC 602A from R1's physician prior to moving the resident into the facility. F1 stated R1's physician visited R1 at the facility and completed the medical assessment on 02/16/2026. Deficiencies were cited per California Code of Regulations, Title 22. See LIC 809-D. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator, Syeda Haroon and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(3) · Plan of correction due date: Mar 25, 2026

87457 Pre-Admission Appraisal (c)(3) The prospective resident, or his/her responsible person, if any, shall be involved in the development of the appraisal. This requirement was not met as evidenced by: Based on review of resident records, R1-R3's Apraisal/ Needs and Services Plan was created but it was not signed by the resident or his/her responsible party which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: Administrator stated to submit a written plan of action understanding regulation and will ensure resident's Appraisal/Needs and Services Plan is signed by resident or his/her responsible person by POC due date. Administrator agreed and understood.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Mar 25, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement was not met as evidenced by: Based on review of resident's records, R1's LIC 602A Physician's Assessment for Residential Care Facilities for the Elderly was completed on 02/16/2026 and R1 was moved into the facility prior to the assessment on 01/09/2026 which poses/the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: Administrator stated to submit a written plan of action understanding regulation and will ensure prior to resident's acceptance to the facility a medical assessment shall be obtained by POC due date. Administrator agreed and understood. (con't) posed a potential health, safety or personal rights risk to persons in care.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. Administrator, Syeda Haroon was contacted but was unavailable during time of visit. LPA met with designated Administrator, Dulce Rose Cera During visit, LPA toured the facility to include 5 resident bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry room, garage, backyard and exterior. All emergency exit routes were free and clear of obstruction. The front door and backyard door observed with operable door alarms. There was 2 staff present to 6 residents. Both staff are fingerprint cleared and associated to the facility. Facility temperature maintained at 77 degrees F. Fire extinguisher last serviced on 06/17/2025. Carbon monoxide detector present and observed operable. Facility has at least 2 days worth of perishables. LPA observed only 24 cans of non-perishable foods in the facility for 6 residents. LPA observed additional items of non-perishable foods to include 3 packages of crackers, 1 pack of cookies, 1.5 packs of apple sauce, and container for cereal. Facility was provided a technical advisory on Title 22 regulation Section 87555 - General Food Service Requirements advising that the facility shall maintain minimum of 7 days worth of nonperishable foods at all times. Refrigerator temperature maintained at 37 degrees F. Freezer temperature maintained at -2 degrees F. Items inside the refrigerator observed covered and labeled. Page 1 of 3. The chemicals, disinfectants, and toxins are stored separately from the food supply. The drawer and cabinet containing sharp objects, chemicals, and disinfectants observed closed with a lock but LPA observed the drawer and cabinets were unlocked upon opening. All resident's are non-ambulatory and require staff assistance when ambulating. During visit, facility staff locked the cabinets and drawers that contains sharps and toxins. Facility was provided a technical advisory on Title 22 regulation on Section 87309(a) - Storage Space and Access. Designated Administrator stated understanding. Resident bedrooms equipped with beds, linens, dressers, night stand, and adequate lighting. Bathroom equipped with grab bars in the shower and next to the toilet and non-slip mats in the shower. Hygiene products and paper supplies observed. Bathroom hot water temperature in the hallway and master bedroom was measured. The hallway hot water temperature measured at 135.6 degrees F and the master bedroom hot water temperature maintained at 136.5 degrees F. A type A deficiency is being cited today in violation of Title 22 Section 87303 - Maintenance and Operation for the hot water temperature exceeding 120 degrees F. There are 2 residents under hospice care. Bedroom #2, #3, and #4 equipped with full bed rails in which 1 out of 3 residents are under hospice care and the physician's order for full rails is listed in the hospice care plan. 2 out of the 3 resident's (R1 & R2) is not under hospice care but utilizes full bed rails. Based on review of the facility file, the facility did not request for an exception for the use of full bed rails nor did the facility obtain a physician's order for the full rails. Facility was advised. A type A deficiency is being cited today in violation of Title 22 Section 87608 - Postural Supports wherein 2 residents who are not receiving hospice care is utilizing full length bed rails which are prohibited unless granted approval from the Department. 4 resident files were reviewed. 3 out of 4 resident files were observed complete and up-to-date. 1 out of the 4 resident's (R1) file did not contain a medical assessment prior to admission. A type B deficiency is being cited today in violation of Title 22 Section 87458 - Medical Assessment wherein the facility did not obtain a physician's report prior to admitting R1. Page 2 of 3. 3 out of 4 residents centrally stored medications and centrally stored medication records (CSMR) were reviewed and issues were noted for resident R2 - R4. There was 2 medications not written in the CSMR for R2, 6 medications not written in the CSMR for R3, and 2 medications not written in the CSMR for R4. A type B deficiency is being cited today in violation of Title 22 Section 87506(a) - Resident Records wherein 3 residents (R2 - R4) centrally stored medications were not maintained as there was a total of 10 medications that were not written in the CSMR. 3 staff files were reviewed and observed complete to include an active first aid certification, fingerprint clearance, health screening, TB result, and annual training per Title 22 regulations. Facility has an emergency disaster plan and LPA advised Administrator to update the emergency disaster plan annually. Facility has emergency lighting available when needed. First aid kit observed. Based on record review, the emergency drills were completed in 2024 but during visit, there was no record to show the emergency drills were completed for this year. The last drill completed and recorded was for December 2024. A type B deficiency is being cited today in violation of Title 22 HCS 1569.695(c) as the facility has not completed quarterly emergency drills as required. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. Advisory note also provided. This report was reviewed with designated Administrator, Dulce Rose Cera and a copy of the report and appeal rights were provided. Page 3 of 3.the state’s words, verbatim · CDSS document, Aug 11, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Facility staff left resident in soiled diapers for hours Facility staff did not feed resident

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the findings of the above allegations. LPA met with Administrator, Syeda Haroon. On 03/11/2025, the Department received the complaint. On 03/20/2025, the initial complaint investigation was conducted. The following documents were obtained to include resident roster, resident (R1)'s physician's report, preplacement appraisal, progress notes, ADL log, care plan, admission agreement, hospital discharge paperwork, and facility menu. It was alleged that the facility staff left resident soiled in diapers for hours. It was alleged that when the resident asked the staff to change his/her diaper the staff will take hours to return, but the resident was unable to recall the last time this happened. Page 1 of 3. Unfounded Based on record review, R1 lived in the facility for only 5 days from 03/05/2025 – 03/09/2025. 3 staff members were interviewed. Based on staff interview, resident (R1) was very demanding and asked to be changed at every hour, even when he/she was dry. It was stated that the facility staff changed R1’s diapers every couple hours, or as needed if resident was soiled. The facility staff logged each time they change, turn and repositioned R1. 1 witness (W1) was interviewed. Based on witness interview, it was stated that R1 asked to be changed and wiped at every hour during the night. W1 states that he/she tried to accommodate to R1's needs and assisted R1 at every request. W1 states there to be one time where W1 was on break eating lunch at the facility's kitchen table where R1 asked to be changed. W1 states that he/she informed R1 that he/she will be back and came back in 15 minutes. W1 denied coming back after an hour. 3 out of 3 staff denied leaving a resident and R1 soiled for a long period of time. 1 resident was interviewed. 4 out of 5 resident interviews were attempted. Based on resident interview, the resident denied being left in soiled diapers for a long time. Resident states that the staff assist him/her whenever he/she needs assistance. Resident stated the staff responds to him/her right away and never had to wait more than 10 minutes for help. Based on record review of the facility’s activities of daily living (ADL) log, it shows that R1 diaper was changed every 2-3 hours from 03/05/2025 – 03/09/2025. It was alleged that the facility staff did not feed resident as the resident stated that he/she had not eaten. Page 2 of 3. 3 staff members were interviewed. Based on staff interview, 3 out of 3 staff states that each resident is provided 3 meals a day and a snack in between, if requested. Staff stated a time where R1 requested food that they did not have at the time but R1 was always offered alternatives. Staff denied R1 ever missing a meal. It was stated that they log each time the resident is provided a meal. 1 resident was interviewed. 4 out of 5 resident interviews were attempted. Based on resident interview, it was stated that the residents are provided 3 meals a day. Resident denied missing a meal. During visit on 03/20/2025, LPA observed 2 residents eating breakfast inside their bedrooms. One resident was served pancakes, fruit salad, and coffee that morning. The second resident was observed eating breakfast in his/her room with the assistance of staff. It stated that the remainder of the resident’s wake up earlier, therefore, was fed breakfast earlier. Based on observation of the facility’s food supplies, the facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. The review of records show that R1 was provided 3 meals a day and snacks in between. The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded, meaning the allegations are false, could not have happened, and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Syeda Haroon and a copy of the report was provided. Page 3 of 3.the state’s words, verbatim · CDSS document, May 28, 2025 · control 26-AS-20250311101843

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Dolores arrived announced to conduct the pre-licensing inspection. LPA met with Dulce Rose Cera and Syeda Mamoona Omer. The facility has an approved fire clearance for 6 non-ambulatory, in which 1 may bed bedridden. Bedridden residents is approved to reside in room #5. During visit, LPA toured the interior to include 5 resident bedrooms, 1 staff bedroom, bathrooms, living room, dining room, kitchen, garage, and exterior. All fire exit routes are free and clear of obstruction. Exit routes contains ramps. Fire extinguisher last serviced on 02/09/2024. Carbon monoxide detector, complete first aid kit, and emergency lightings observed present. The backyard contains a shed and observed with storage items. Interior temperature maintained at 71 degrees Fahrenheit. Kitchen is equipped with a locked cabinet to store items that will be kept inaccessible to residents. LPA observed sufficient cups, plates, bowls, and utensils. Facility is equipped with at least 7 days worth of non-perishables and 2 days worth of perishable foods. Refrigerator temperature maintained at 37 degrees Fahrenheit. Freezer temperature maintained at -1 degrees Fahrenheit. Bedrooms equipped with beds, linens, adequate lighting, chair, night-stand, and dresser. Hot water temperature maintained at 106 degrees Fahrenheit. Bathroom shower contains non-slip mats. Bathroom #1 and #5 observed with a grab bar. Laundry room observed with locked cabinets. Facility has an area to lock medications and records. Posters observed to include the licensing complaint poster, ombudsman, personal rights, rights of resident council, house rules, activities, and emergency disaster plan. COMP III completed with Dulce Rose Cera, Syeda Mamoona Omer, and Syeda Lubna Haroon No issues noted during the pre-licensing inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Dulce Rose Cera and Syeda Mamoona Omer and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 26, 2024